Conjunctival adhesions (Symblepharon) - Remove or leave alone?

Greetings and thanks 🙏 for reading this. We’re a multi pet household with 5 cats. 2 weeks ago we adopted a shelter kitten. Loki is -6 months old, 7.5 lb beautiful black domestic shorthair. Loki had viral and bacterial infections that led to the condition in subject. His right eye vision is ~90% blocked by it. We don’t know how long ago it happened, and how much cornea damage there is underneath. Next week he is going to be neutered, and the vet suggested that we can try and remove the adhesion while he is anesthetized which may restore some of his vision. He explained that there are risks involved that in the worst case may cause the eye to rapture and that he will need treatments for 2 weeks. Loki is the most gentle and friendly creature so treating his eye should not be an issue. However, even with his vision deficiency, Loki shows no obvious physical limitations. We had vision impaired cats before so we know how to read their behavior. We’re contemplating whether the potential benefits of the procedure outweigh the risks.  I would appreciate your knowledgeable thoughts and experienced advice. Thanks again 🙏 and have an amazing day! Amy

Hello - this is not a condition or surgery that I am familiar with.  There was a retrospective study published in the Journal of Feline Medicine and Surgery, February 2023 by Shiraishi, Vernau and Maggs - I beleive at the University of California and it may be available online.  These people looked at 40 affected kittens (54 affected eyes) and seemed to conclude that some presentations of Symblepharon were much more ameanable to treatment than others.  For example, adhesions joining conjunctiva to conjunctiva had more successful surgical treatment than adhesions between the conjunctiva and cornea (the front of the eye).  What is true of your cats' condition?  Which group would they fall into?  The study also suggested that any keratoconjuncitivits should be treated at the same time if possible and - perhaps most importantly - that Symblepharon is not a single condition / presentation than can be treated in the same way every time, but a group of different conditions that may need to be approached and assessed differently. Therefore, my questions to the vet might be, 'How many of these surgeries have you done before?  What was your success rate?  What are the possible findings underneath those eyelids?  How does this affect the possible outcomes?  And furthermore, are there doctors in the area more used to operating on these eyes than yourselves?  e.g. opthalmological specialists.  If appropriate, is there any chance of a referral?'  If a referral is not on the cards, you could ask what is the best (and worst) likely outcome that could happen if a) the surgery went ahead and went well, b) the surgery wet ahead and didn't go well and c) the surgery didn't go ahead.   How could a specialist improve these odds?    These are good questions to help you to prepare your expectations for surgery and can be useful when it comes to making decisions.  I'm sorry that you have this decision to make and wish you both well.

Thank you Dr. Buchanan. Loki’s adhesion is to the cornea. Thanks for the data and for your thoughtful question process. It will be helpful for our decision. have a great weekend!